Efficacy of transcranial direct current stimulation (tDCS) in reducing consumption in patients with alcohol use disorders: study protocol for a randomized controlled trial
Approximately 15 million persons in the European Union and 10 million persons in the USA are alcohol-dependent. The global burden of disease and injury attributable to alcohol is considerable: worldwide, approximately one in 25 deaths in 2004 was caused by alcohol. At the same time, alcohol use diso...
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creator | Trojak, Benoit Soudry-Faure, Agnès Abello, Nicolas Carpentier, Maud Jonval, Lysiane Allard, Coralie Sabsevari, Foroogh Blaise, Emilie Ponavoy, Eddy Bonin, Bernard Meille, Vincent Chauvet-Gelinier, Jean-Christophe |
description | Approximately 15 million persons in the European Union and 10 million persons in the USA are alcohol-dependent. The global burden of disease and injury attributable to alcohol is considerable: worldwide, approximately one in 25 deaths in 2004 was caused by alcohol. At the same time, alcohol use disorders remain seriously undertreated. In this context, alternative or adjunctive therapies such as brain stimulation may play a prominent role. The early results of studies using transcranial direct current stimulation found that stimulations delivered to the dorsolateral prefrontal cortex result in a significant reduction of craving and an improvement of the decision-making processes in various additive disorders. We, therefore, hypothesize that transcranial direct current stimulation can lead to a decrease in alcohol consumption in patients suffering from alcohol use disorders.
We report the protocol of a randomized, double-blind, placebo-controlled, parallel-group trial, to evaluate the efficacy of transcranial direct current stimulation on alcohol reduction in patients with an alcohol use disorder. The study will be conducted in 14 centers in France and Monaco. Altogether, 340 subjects over 18 years of age and diagnosed with an alcohol use disorder will be randomized to receive five consecutive twice-daily sessions of either active or placebo transcranial direct current stimulation. One session consists in delivering a current flow continuously (anode F4; cathode F3) twice for 13 minutes, with treatments separated by a rest interval of 20 min. Efficacy will be evaluated using the change from baseline (alcohol consumption during the 4 weeks before randomization) to 24 weeks in the total alcohol consumption and number of heavy drinking days. Secondary outcome measures will include alcohol craving, clinical and biological improvements, and the effects on mood and quality of life, as well as cognitive and safety assessments, and, for smokers, an assessment of the effects of transcranial direct current stimulation on tobacco consumption.
Several studies have reported a beneficial effect of transcranial direct current stimulation on substance use disorders by reducing craving, impulsivity, and risk-taking behavior, and suggest that transcranial direct current stimulation may be a promising treatment in addiction. However, to date, no studies have included sufficiently large samples and sufficient follow-up to confirm the hypothesis. Results from this large randomiz |
doi_str_mv | 10.1186/s13063-016-1363-8 |
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We report the protocol of a randomized, double-blind, placebo-controlled, parallel-group trial, to evaluate the efficacy of transcranial direct current stimulation on alcohol reduction in patients with an alcohol use disorder. The study will be conducted in 14 centers in France and Monaco. Altogether, 340 subjects over 18 years of age and diagnosed with an alcohol use disorder will be randomized to receive five consecutive twice-daily sessions of either active or placebo transcranial direct current stimulation. One session consists in delivering a current flow continuously (anode F4; cathode F3) twice for 13 minutes, with treatments separated by a rest interval of 20 min. Efficacy will be evaluated using the change from baseline (alcohol consumption during the 4 weeks before randomization) to 24 weeks in the total alcohol consumption and number of heavy drinking days. Secondary outcome measures will include alcohol craving, clinical and biological improvements, and the effects on mood and quality of life, as well as cognitive and safety assessments, and, for smokers, an assessment of the effects of transcranial direct current stimulation on tobacco consumption.
Several studies have reported a beneficial effect of transcranial direct current stimulation on substance use disorders by reducing craving, impulsivity, and risk-taking behavior, and suggest that transcranial direct current stimulation may be a promising treatment in addiction. However, to date, no studies have included sufficiently large samples and sufficient follow-up to confirm the hypothesis. Results from this large randomized controlled trial will give a better overview of the therapeutic potential of transcranial direct current stimulation in alcohol use disorders.
Clinical Trials Gov, NCT02505126 (registration date: July 15 2015).</description><identifier>ISSN: 1745-6215</identifier><identifier>EISSN: 1745-6215</identifier><identifier>DOI: 10.1186/s13063-016-1363-8</identifier><identifier>PMID: 27188795</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Abstinence ; Affect ; Alcohol Abstinence ; Alcohol Drinking - physiopathology ; Alcohol Drinking - prevention & control ; Alcohol Drinking - psychology ; Alcohol use ; Alcohol-Related Disorders - diagnosis ; Alcohol-Related Disorders - physiopathology ; Alcohol-Related Disorders - psychology ; Alcohol-Related Disorders - therapy ; Alcoholics ; Alcoholism ; Analysis ; Care and treatment ; Clinical Protocols ; Clinical trials ; Cognition ; Cognition & reasoning ; Craving ; Delirium ; Double-Blind Method ; Drinking of alcoholic beverages ; Female ; France ; Health aspects ; Humans ; Male ; Medical equipment ; Mental disorders ; Monaco ; Patients ; Psychiatric Status Rating Scales ; Quality of Life ; Research Design ; Risk factors ; Smoking - psychology ; Study Protocol ; Substance abuse ; Surveys and Questionnaires ; Time Factors ; Tobacco ; Transcranial Direct Current Stimulation - adverse effects ; Treatment Outcome ; Womens health</subject><ispartof>Current controlled trials in cardiovascular medicine, 2016-05, Vol.17 (1), p.250-250, Article 250</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>Trojak et al. 2016. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Trojak et al. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-4d0597e36d9f146dc7d444eef4582cd9060d5785eb92fa2eac89e466ca9e33a93</citedby><cites>FETCH-LOGICAL-c494t-4d0597e36d9f146dc7d444eef4582cd9060d5785eb92fa2eac89e466ca9e33a93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869375/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869375/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27188795$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Trojak, Benoit</creatorcontrib><creatorcontrib>Soudry-Faure, Agnès</creatorcontrib><creatorcontrib>Abello, Nicolas</creatorcontrib><creatorcontrib>Carpentier, Maud</creatorcontrib><creatorcontrib>Jonval, Lysiane</creatorcontrib><creatorcontrib>Allard, Coralie</creatorcontrib><creatorcontrib>Sabsevari, Foroogh</creatorcontrib><creatorcontrib>Blaise, Emilie</creatorcontrib><creatorcontrib>Ponavoy, Eddy</creatorcontrib><creatorcontrib>Bonin, Bernard</creatorcontrib><creatorcontrib>Meille, Vincent</creatorcontrib><creatorcontrib>Chauvet-Gelinier, Jean-Christophe</creatorcontrib><title>Efficacy of transcranial direct current stimulation (tDCS) in reducing consumption in patients with alcohol use disorders: study protocol for a randomized controlled trial</title><title>Current controlled trials in cardiovascular medicine</title><addtitle>Trials</addtitle><description>Approximately 15 million persons in the European Union and 10 million persons in the USA are alcohol-dependent. The global burden of disease and injury attributable to alcohol is considerable: worldwide, approximately one in 25 deaths in 2004 was caused by alcohol. At the same time, alcohol use disorders remain seriously undertreated. In this context, alternative or adjunctive therapies such as brain stimulation may play a prominent role. The early results of studies using transcranial direct current stimulation found that stimulations delivered to the dorsolateral prefrontal cortex result in a significant reduction of craving and an improvement of the decision-making processes in various additive disorders. We, therefore, hypothesize that transcranial direct current stimulation can lead to a decrease in alcohol consumption in patients suffering from alcohol use disorders.
We report the protocol of a randomized, double-blind, placebo-controlled, parallel-group trial, to evaluate the efficacy of transcranial direct current stimulation on alcohol reduction in patients with an alcohol use disorder. The study will be conducted in 14 centers in France and Monaco. Altogether, 340 subjects over 18 years of age and diagnosed with an alcohol use disorder will be randomized to receive five consecutive twice-daily sessions of either active or placebo transcranial direct current stimulation. One session consists in delivering a current flow continuously (anode F4; cathode F3) twice for 13 minutes, with treatments separated by a rest interval of 20 min. Efficacy will be evaluated using the change from baseline (alcohol consumption during the 4 weeks before randomization) to 24 weeks in the total alcohol consumption and number of heavy drinking days. Secondary outcome measures will include alcohol craving, clinical and biological improvements, and the effects on mood and quality of life, as well as cognitive and safety assessments, and, for smokers, an assessment of the effects of transcranial direct current stimulation on tobacco consumption.
Several studies have reported a beneficial effect of transcranial direct current stimulation on substance use disorders by reducing craving, impulsivity, and risk-taking behavior, and suggest that transcranial direct current stimulation may be a promising treatment in addiction. However, to date, no studies have included sufficiently large samples and sufficient follow-up to confirm the hypothesis. Results from this large randomized controlled trial will give a better overview of the therapeutic potential of transcranial direct current stimulation in alcohol use disorders.
Clinical Trials Gov, NCT02505126 (registration date: July 15 2015).</description><subject>Abstinence</subject><subject>Affect</subject><subject>Alcohol Abstinence</subject><subject>Alcohol Drinking - physiopathology</subject><subject>Alcohol Drinking - prevention & control</subject><subject>Alcohol Drinking - psychology</subject><subject>Alcohol use</subject><subject>Alcohol-Related Disorders - diagnosis</subject><subject>Alcohol-Related Disorders - physiopathology</subject><subject>Alcohol-Related Disorders - psychology</subject><subject>Alcohol-Related Disorders - therapy</subject><subject>Alcoholics</subject><subject>Alcoholism</subject><subject>Analysis</subject><subject>Care and treatment</subject><subject>Clinical Protocols</subject><subject>Clinical trials</subject><subject>Cognition</subject><subject>Cognition & reasoning</subject><subject>Craving</subject><subject>Delirium</subject><subject>Double-Blind Method</subject><subject>Drinking of alcoholic beverages</subject><subject>Female</subject><subject>France</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Male</subject><subject>Medical equipment</subject><subject>Mental disorders</subject><subject>Monaco</subject><subject>Patients</subject><subject>Psychiatric Status Rating Scales</subject><subject>Quality of Life</subject><subject>Research Design</subject><subject>Risk factors</subject><subject>Smoking - psychology</subject><subject>Study Protocol</subject><subject>Substance abuse</subject><subject>Surveys and Questionnaires</subject><subject>Time Factors</subject><subject>Tobacco</subject><subject>Transcranial Direct Current Stimulation - adverse effects</subject><subject>Treatment Outcome</subject><subject>Womens health</subject><issn>1745-6215</issn><issn>1745-6215</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNptUk1vFSEUnRiNrdUf4MaQuKmLqTB8DLgwaZ71I2niQl0TCpf3aJjhCYym_iX_pDxfra0xJHBz7znncuF03VOCTwiR4mUhFAvaYyJ6Qlsg73WHZGS8FwPh92_FB92jUi4xZlRR9rA7GEYi5aj4YffzzPtgjb1CyaOazVxs24KJyIUMtiK75AxzRaWGaYmmhjSj4_pm9ekFCjPK4BYb5jWyaS7LtP1dbvltAzZWQd9D3SATbdqkiJYCTbak7CCXV01ycVdom1NNtlV9ysig1t2lKfwAt9OsOcXYwprblR53D7yJBZ5cn0fdl7dnn1fv-_OP7z6sTs97yxSrPXOYqxGocMoTJpwdHWMMwDMuB-sUFtjxUXK4UIM3AxgrFTAhrFFAqVH0qHu9190uFxM42wbJJuptDpPJVzqZoO9W5rDR6_RNMykUHXkTOL4WyOnrAqXqKRQLMZoZ0lI0GRXGwyA5a9Dn_0Av05LnNp4e2gcNfFCK_kWtTQQdZp9aX7sT1adMUEkkxzvUyX9QbTmYQntM8KHl7xDInmBzKiWDv5mRYL1zmN47TDeH6Z3DtGycZ7cf54bxx1L0F17tz9E</recordid><startdate>20160517</startdate><enddate>20160517</enddate><creator>Trojak, Benoit</creator><creator>Soudry-Faure, Agnès</creator><creator>Abello, Nicolas</creator><creator>Carpentier, Maud</creator><creator>Jonval, Lysiane</creator><creator>Allard, Coralie</creator><creator>Sabsevari, Foroogh</creator><creator>Blaise, Emilie</creator><creator>Ponavoy, Eddy</creator><creator>Bonin, Bernard</creator><creator>Meille, Vincent</creator><creator>Chauvet-Gelinier, Jean-Christophe</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160517</creationdate><title>Efficacy of transcranial direct current stimulation (tDCS) in reducing consumption in patients with alcohol use disorders: study protocol for a randomized controlled trial</title><author>Trojak, Benoit ; Soudry-Faure, Agnès ; Abello, Nicolas ; Carpentier, Maud ; Jonval, Lysiane ; Allard, Coralie ; Sabsevari, Foroogh ; Blaise, Emilie ; Ponavoy, Eddy ; Bonin, Bernard ; Meille, Vincent ; Chauvet-Gelinier, Jean-Christophe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-4d0597e36d9f146dc7d444eef4582cd9060d5785eb92fa2eac89e466ca9e33a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abstinence</topic><topic>Affect</topic><topic>Alcohol Abstinence</topic><topic>Alcohol Drinking - physiopathology</topic><topic>Alcohol Drinking - prevention & control</topic><topic>Alcohol Drinking - psychology</topic><topic>Alcohol use</topic><topic>Alcohol-Related Disorders - diagnosis</topic><topic>Alcohol-Related Disorders - physiopathology</topic><topic>Alcohol-Related Disorders - psychology</topic><topic>Alcohol-Related Disorders - therapy</topic><topic>Alcoholics</topic><topic>Alcoholism</topic><topic>Analysis</topic><topic>Care and treatment</topic><topic>Clinical Protocols</topic><topic>Clinical trials</topic><topic>Cognition</topic><topic>Cognition & reasoning</topic><topic>Craving</topic><topic>Delirium</topic><topic>Double-Blind Method</topic><topic>Drinking of alcoholic beverages</topic><topic>Female</topic><topic>France</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Male</topic><topic>Medical equipment</topic><topic>Mental disorders</topic><topic>Monaco</topic><topic>Patients</topic><topic>Psychiatric Status Rating Scales</topic><topic>Quality of Life</topic><topic>Research Design</topic><topic>Risk factors</topic><topic>Smoking - psychology</topic><topic>Study Protocol</topic><topic>Substance abuse</topic><topic>Surveys and Questionnaires</topic><topic>Time Factors</topic><topic>Tobacco</topic><topic>Transcranial Direct Current Stimulation - adverse effects</topic><topic>Treatment Outcome</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trojak, Benoit</creatorcontrib><creatorcontrib>Soudry-Faure, Agnès</creatorcontrib><creatorcontrib>Abello, Nicolas</creatorcontrib><creatorcontrib>Carpentier, Maud</creatorcontrib><creatorcontrib>Jonval, Lysiane</creatorcontrib><creatorcontrib>Allard, Coralie</creatorcontrib><creatorcontrib>Sabsevari, Foroogh</creatorcontrib><creatorcontrib>Blaise, Emilie</creatorcontrib><creatorcontrib>Ponavoy, Eddy</creatorcontrib><creatorcontrib>Bonin, Bernard</creatorcontrib><creatorcontrib>Meille, Vincent</creatorcontrib><creatorcontrib>Chauvet-Gelinier, Jean-Christophe</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Current controlled trials in cardiovascular medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trojak, Benoit</au><au>Soudry-Faure, Agnès</au><au>Abello, Nicolas</au><au>Carpentier, Maud</au><au>Jonval, Lysiane</au><au>Allard, Coralie</au><au>Sabsevari, Foroogh</au><au>Blaise, Emilie</au><au>Ponavoy, Eddy</au><au>Bonin, Bernard</au><au>Meille, Vincent</au><au>Chauvet-Gelinier, Jean-Christophe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of transcranial direct current stimulation (tDCS) in reducing consumption in patients with alcohol use disorders: study protocol for a randomized controlled trial</atitle><jtitle>Current controlled trials in cardiovascular medicine</jtitle><addtitle>Trials</addtitle><date>2016-05-17</date><risdate>2016</risdate><volume>17</volume><issue>1</issue><spage>250</spage><epage>250</epage><pages>250-250</pages><artnum>250</artnum><issn>1745-6215</issn><eissn>1745-6215</eissn><abstract>Approximately 15 million persons in the European Union and 10 million persons in the USA are alcohol-dependent. The global burden of disease and injury attributable to alcohol is considerable: worldwide, approximately one in 25 deaths in 2004 was caused by alcohol. At the same time, alcohol use disorders remain seriously undertreated. In this context, alternative or adjunctive therapies such as brain stimulation may play a prominent role. The early results of studies using transcranial direct current stimulation found that stimulations delivered to the dorsolateral prefrontal cortex result in a significant reduction of craving and an improvement of the decision-making processes in various additive disorders. We, therefore, hypothesize that transcranial direct current stimulation can lead to a decrease in alcohol consumption in patients suffering from alcohol use disorders.
We report the protocol of a randomized, double-blind, placebo-controlled, parallel-group trial, to evaluate the efficacy of transcranial direct current stimulation on alcohol reduction in patients with an alcohol use disorder. The study will be conducted in 14 centers in France and Monaco. Altogether, 340 subjects over 18 years of age and diagnosed with an alcohol use disorder will be randomized to receive five consecutive twice-daily sessions of either active or placebo transcranial direct current stimulation. One session consists in delivering a current flow continuously (anode F4; cathode F3) twice for 13 minutes, with treatments separated by a rest interval of 20 min. Efficacy will be evaluated using the change from baseline (alcohol consumption during the 4 weeks before randomization) to 24 weeks in the total alcohol consumption and number of heavy drinking days. Secondary outcome measures will include alcohol craving, clinical and biological improvements, and the effects on mood and quality of life, as well as cognitive and safety assessments, and, for smokers, an assessment of the effects of transcranial direct current stimulation on tobacco consumption.
Several studies have reported a beneficial effect of transcranial direct current stimulation on substance use disorders by reducing craving, impulsivity, and risk-taking behavior, and suggest that transcranial direct current stimulation may be a promising treatment in addiction. However, to date, no studies have included sufficiently large samples and sufficient follow-up to confirm the hypothesis. Results from this large randomized controlled trial will give a better overview of the therapeutic potential of transcranial direct current stimulation in alcohol use disorders.
Clinical Trials Gov, NCT02505126 (registration date: July 15 2015).</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27188795</pmid><doi>10.1186/s13063-016-1363-8</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Abstinence Affect Alcohol Abstinence Alcohol Drinking - physiopathology Alcohol Drinking - prevention & control Alcohol Drinking - psychology Alcohol use Alcohol-Related Disorders - diagnosis Alcohol-Related Disorders - physiopathology Alcohol-Related Disorders - psychology Alcohol-Related Disorders - therapy Alcoholics Alcoholism Analysis Care and treatment Clinical Protocols Clinical trials Cognition Cognition & reasoning Craving Delirium Double-Blind Method Drinking of alcoholic beverages Female France Health aspects Humans Male Medical equipment Mental disorders Monaco Patients Psychiatric Status Rating Scales Quality of Life Research Design Risk factors Smoking - psychology Study Protocol Substance abuse Surveys and Questionnaires Time Factors Tobacco Transcranial Direct Current Stimulation - adverse effects Treatment Outcome Womens health |
title | Efficacy of transcranial direct current stimulation (tDCS) in reducing consumption in patients with alcohol use disorders: study protocol for a randomized controlled trial |
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